A cost‐effectiveness study of changing medical practice in early pregnancy

Abstract

Until recent years women with symptoms consistent with miscarriage either referred themselves or were referred by their doctors to the local Accident and Emergency (A&E) department. This generally resulted in admission to a gynaecological ward and delayed treatment. Examines the costs and benefits of an Early Pregnancy Assessment Clinic (EPAC), at a teaching hospital in North East England, to deal with the complications in the first trimester. The data show clear benefits together with cost savings. There is an unambiguous policy recommendation to implement the proposed clinic. Examines the delivery of service provision and the impact on referral patterns to the A&E department. Raises the issue of care provision at the margin. Finally, shows the results of an evaluative survey of the clinic from returns of a questionnaire sent to and completed by local general practitioners.

Management of women referred to an acute gynecology unit: impact of an ultrasound‐based model of care

“…AGUs are currently being introduced in various hospitals across the UK, but with little prospective validation of such ultrasound‐based models of care. Wren and Craven6 found benefit to the patient and cost savings on introduction of an early pregnancy evaluation clinic instead of ED referral for women with miscarriage symptoms. Bigrigg and Read2 also demonstrated a benefit to women in early pregnancy with the introduction of an ultrasound‐based EPU, their study being the first before‐and‐after study to evaluate the impact of EPUs.…”

The early pregnancy assessment project: The effect of cooperative care in the emergency department for management of early pregnancy complications

“…Ordering of pathology and imaging causes significant delay in finalising a clinical encounter due to performance of the tests, waiting for result to be verified and finally informing the patient 12 and this is particularly relevant to ultrasound. A 168% increase of clinician‐performed bedside ultrasound coupled with an 85% decrease in formal imaging services is biggest contributor to removing nearly three hours (166 min) of treatment time for each pregnancy problem resolved in this study.…”

“…This study demonstrates that EPAC style services can be delivered, beginning from within the ED where a need exists, providing a real alternative pathway compared to traditional ED care. Dedicated EPAC have been around for a long time now and have demonstrated efficiency and improved quality of care compared to inpatient management 6,12 . However, referral of EPP from the ED to EPAC unfortunately has now become standard management practice where it may be more appropriate to resolve the EPP in the ED using available resources.…”

“…For a long period, approaching nearly 20 years and particularly in the UK, the establishment of EPAC services has improved quality of care, decreased admissions and had a positive impact on staff and financial factors 6,7 . Recently a decrease in the length of stay and representations to the ED has been described from referral of patients to a dedicated EPAC from the ED 2 .…”

Cost-effectiveness of ultrasound use by on-call registrars in an acute gynaecology setting

“…Th e one-stop ultrasound-based model of care in early pregnancy units (EPUs) has been shown to improve the quality of care and produce signifi cant savings through the reduction of hospital admissions by 40% with a further 20% of those admitted requiring a shorter hospital stay (Bigrigg and Read 1991;Bradley and Hamilton-Fairley 1998;Wren and Craven 1999). Th is model of care in EPUs has been mirrored in acute gynaecology units (AGUs), which are gradually spreading.…”